Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | NA | NY |
NPI | 1003088964 |
---|---|
Provider Name | Mr. Robert Joseph Miela |
First Address | Ridgewood, NY 11385-2534 |
Second Address | New York, NY 10003-7902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2008 |
Last Update Date | 31/03/2008 |